Obstructive Sleep Apnea (OSA) Granted Secondary to Service-Connected PTSD With Obesity as an Intermediate Step

This U.S. Marine Corps veteran had an established service connection for Post - Traumatic Stress Disorder (PTSD) and a medically confirmed diagnosis of severe Obstructive Sleep Apnea (OSA).

When the veteran sought VA disability compensation for OSA as a secondary condition, the claim was denied. The VA attributed the condition primarily to obesity and did not recognize a secondary relationship between PTSD and OSA.

• Service connection for Post-Traumatic Stress Disorder (PTSD).
• A confirmed diagnosis of severe Obstructive Sleep Apnea (OSA) supported by sleep study evidence.
• Medical documentation of chronic sleep disruption, excessive daytime fatigue, and impaired daily functioning.
• Class II obesity, which the VA cited as the primary cause of OSA.
• No medical opinion addressing whether PTSD caused or aggravated the veteran’s OSA, or whether obesity functioned as an intermediate factor rather than an independent cause

A comprehensive review of the veteran’s medical records, sleep studies, and PTSD symptom history was conducted to assess whether a secondary service connection could be medically supported.

• Key steps included:
• Evaluating the physiological and behavioral effects of PTSD on sleep architecture and respiratory function.
• Reviewing medical literature regarding the relationship between PTSD, sleep disruption, and the development or worsening of OSA.
• Analyzing whether obesity acted as an intermediate step influenced by PTSD-related symptoms rather than a sole etiology.
• Coordinating the preparation of a medical nexus opinion that clearly addressed causation and aggravation using VA-recognized standards